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Transcript of NIMS (National Incident Management System) for Healthcare Based upon Emergency Management Institute...
NIMS (National Incident Management System) for Healthcare
Based upon Emergency Management Institute ICS-700
Minnesota Emergency Readiness Education and Training Program
(MERET)
MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training
MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator.
Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.
Hospital Command & General Staff
Objectives
Identify the key principles of NIMS in the context of healthcare.
Recall when it is appropriate to initiate an Area Command. Name the functions and purpose of a Multiagency
Coordination Center. Select the appropriate utilization of the Public Information
Systems within NIMS. Compare how NIMS and HICS affect how healthcare
prepares for incidents and events. Recognize the concepts and principles of resource
management under NIMS & HICS. Identify the benefits of common communication and
information management standards.
What is NIMS?
“ – a consistent nationwide approach for federal, state, tribal, and local governments to work effectively and efficiently together to prepare for, prevent, respond to and recover from domestic incidents, regardless of cause, size or complexity.”
- Secretary of Homeland Security directed President of USA to develop & administer a National Incident Management System (NIMS)
Homeland Security Presidential Directive / HSPD-5, 2003
What is NIMS?
A comprehensive, national approach to incident management
Applicable at all jurisdictional levels and across disciplines
Slide courtesy of FEMA
NIMS Concepts and Principles
NIMS is:
Flexible and Standardized to improve overall response and interoperability and enable all responding organizations to work together.
Slide courtesy of FEMA
NIMS & NRP Relationship
LocalSupport or Response
National Incident Management System (NIMS) Standardized process and procedures for
incident management
StateSupport or Response
FederalSupport or Response
NIMS aligns command & control, organization structure, terminology, communication protocols,
resources and resource typing
National Response Plan (NRP)Activation and proactive application of
integrated Federal resources
Incident
NRP is activated forIncidents of National
Significance
Resources, knowledge,
and abilities from all Federal agencies
DHS integratesand applies Federal
resources
http://www.nrt.org/production/NRT/NRTWeb.nsf/AllAttachmentsByTitle/A-319CharlieHessNIMS-NRPBrief/$File/Charlie_Hess_NIMS-NRP_Brief.ppt?OpenElement#324,6,NIMS & NRP Relationship
Cap
abili
ties
an
d R
eso
urc
es
Federal Response
Regional / Mutual Response SystemsState Response
Increasing magnitude and severity
Local Response, Municipal and County
Tiered Response Strategy
Minimal Low Medium High Catastrophic
'Medical Surge Capacity and Capability Handbook' by J. Barbera and A. Macintyre published by CNA Corporation.
Tiered Response
HCF =Health Care Facility
'Medical Surge Capacity and Capability Handbook' by J. Barbera
and A. Macintyre published by CNA Corporation.
NIMS Training Deadlines
1. August 31, 2007 (ISC-100 HC) Emergency Managers (ICS-100 HC, ICS-200 HC, ICS-700
and IS-800) Command Staff (ICS-100 HC, ICS-200 HC and ICS-700)
• PIO• Liaison Officer• Incident Commander (only Commander title)• Safety Officer
General Staff(ICS-100 HC, ICS-200 HC and ICS-700)• Section Chiefs (Operations, Planning, Logistics, Finance
—the only reference to Chiefs)
2. August 31, 2008 (ISC-100 HC)• Staff filling boxes below section chiefs
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Slide courtesy of FEMA
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Command and Management
Incident Command System (ICS) Hospital Incident Command System (HICS) You learned this in ICS-100 HC and ICS-200
HC• Proven management system based on best
practices• Span of control may vary from 3 – 7• Use common terminology to reduce confusion
between ICS position and day-to-day position• Embraces management-by-objectives in
developing Incident Action Plans• Recognizes Multiagency Coordination Entity when
resources cannot be obtained locally
Slide courtesy of FEMA
Command and Management
In some situations, NIMS recommends variations in incident command
Most common variations are:Unified CommandArea Command
Slide courtesy of FEMA
“Unified Command”
Used when more than one agency is involved such as with a hazardous material spill
Collective / collaborative approach
Agency 1 Agency 2 Agency 3
ONE Incident Action Plan Photos courtesy of FEMA
How Does “Unified Command” Work? Agencies work together to:
Analyze intelligence information Establish single set of objectives & strategies
for multiple agencies Create single Incident Action Plan (IAP) Improved information flow & coordination Agencies understand joint priorities &
restrictions Unified Command does not change other
features of ICS.
Slide courtesy of FEMA
How is “Area Command” Organized?
Area Command
Planning Logistics Finance/ Administration
Slide courtesy of FEMA
What Does “Area Command” Do?
Sets overall strategy and priorities Allocates resources Ensures proper management Ensures objectives are met Ensures strategies are followed Is particularly relevant to public health emergencies because
incidents where area command are used:– Are not site specific– Are not immediately identifiable– Are geographically dispersed and evolve over time
Area Command does not include an Operations Section because operations are conducted on-scene.
May become a “Unified Command Area”
Slide courtesy of FEMA
How is “Area Command” Organized?
Area Command
ICP 1 ICP 2 ICP 3
Slide courtesy of FEMA
Command and Management
“Multiagency Coordination Center” For large or wide-scale emergencies Aids in resource allocation decisions based
on incident priorities Emergency Operations Centers may support
the need for multiagency coordination and Joint Information activities
Handles requests for items that IC cannot obtain locally
Slide courtesy of FEMA
“Multiagency Coordination Center” (MAC)
NOT ‘Area Command’ Function & scope is incident-driven Coordinate incident-related information Resource management center for agencies Strategic planning
Surveillance and Epidemiology Patient Care Population-based Interventions Personnel management
Liaison with jurisdictional agencies and EOCs to coordinate issues regarding incident management policies, priorities & strategies
Slide courtesy of FEMA
MAC
Simple and brief in use or complex and protracted based on event
Coordination Center that can also be activated to assist “Area Command” for:Multiple concurrent health-related incidentsIncidents that are non-site specificIncidents that are geographically dispersedIncidents that evolve over time
Slide courtesy of FEMA
MAC for Health Care
EMS Hospitals Public Health Emergency Management
Activation Site Staffing Authority
Slide courtesy of FEMA
Hospital A
Hospital B
Hospital C
Clinics
Health System
Public HealthAgenciesEMS Agencies
JurisdictionEmergency Management
AA
B
C A
B
C C
B
Regional Hospital Resource Center
Multi-Agency CoordinationCenter
EM EMS PH
Slide courtesy of John Hicks
Command and Management
Public Information coordination across responding agencies is important for the public to receive accurate, timely, and consistent information that is easy to understand
The Public Information Officer (PIO) is part of the command staff PIO operates within the parameters of a Joint
Information System when established as part of a Multiagency Coordination or “Area Command”
Each agency or organization contributing to the Joint Information System retains their organizational independence while using the Joint Information System protocols
Slide courtesy of FEMA
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
How Does NIMS Define Preparedness?
Taking actions to establish and sustain prescribed levels of capability
Ensures mission integration and interoperability
Slide courtesy of FEMA
Comprehensive Emergency Management Cycle
4 Phases:Mitigation – prevention or activities
that reduce impact of hazard Preparedness – build response
capacity/capabilityResponse – gain control of an eventRecovery – return to pre-disaster state
Slide courtesy of FEMA
Community- Based Hazard Vulnerability Analysis (HVA)
(images courtesy of USA.gov)
MDH Regions
Slide courtesy of John Hicks
Preparedness
Mutual Aid Agreements and Emergency Management Assistance Compactsfacilitate timely delivery of assistance
Slide courtesy of FEMA
Preparedness
Metropolitan Hospital Compact Since April 9, 2002 27 hospitals operating 4800 beds 7 counties participate
Agreement provides for: Staff and supply sharing Staffing off-site facilities for first 48h Communications, JPIC Regional Hospital Resource Center (HCMC)
Slide courtesy of John Hicks
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Resource Management
Resource management is an important concept for preparedness organizations at all levels and helps to: Establish guidelines and protocols for
resource management Establish procedures to track resources from
mobilization through demobilization Categorize resources (resource typing)
based on measurable standards of capability and performance
Slide courtesy of FEMA
Resource Management
Regional Hospital Resource Center (RHRC) Designated hospital in a geographic or
functional region that is the coordinating hospital for information and requests
Acts as ‘broker’ for patient transfers into / out of the region
May help make allocation decisions for resources (eg: staffing)
Represents hospital needs and issues to Multi-Agency Coordination Center
Slide courtesy of John Hicks
Capacity vs. Capability
Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’
Surge Capability – ‘the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions’
• Barbera and Macintyre
Alternate Care Site Facilities
e.g., Procedure Centers, Churches, Hotels, Community/
Recreation Centers, Warehouses
Home
Clinics and/orPrivate MDs
Treatment/Triage
In-Home Family Care
LTC Facilities
Urgent Care Centers
Neighborhood Emergency Help
CentersMass Dispensing Clinics
Screening Centers
Homecare
Hospitals
Surge Capacity/Patient Care Coordination
MAC
From the Minnesota Department of Health, Pat Tommet
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Communications & Information Management through the Joint Information System (JIS) Protocols
To ensure consistency among all who respond, all responding agencies must have a common operating picture PIOs operate within the parameters of a JIS Keys to a common operating picture:
• Interoperable communications across all agencies and jurisdictions
• Information systems based on common architecture
Slide courtesy of FEMA
Joint Information Center (JIC)
Physical location where public information staff collocate/organize factual information
Provides the structure for coordinating and disseminating official/critical information
Slide courtesy of FEMA
JIC
State JIC
Local JIC 1 Local JIC 2
Agency 1 PIO
Agency 2 PIO
IC/UC/Area Command
PIO(at incident JIC)
Slide courtesy of FEMA
JIC Characteristics
Includes representatives of all players in the response: both private and public organizations
Has procedures and protocols for communicating and coordinating with other JICs
May be established at various levels of government In case of “Unified Command”—agencies contributing
retain their organizational independence When multiple JICs are established, each JIC
contributes to the overall unified message using joint information system protocols
Slide courtesy of FEMA
JIC Components
Joint Information Center
Research Team Media Team Logistics Team
Press Secretary(jurisdictional)
Liaison(as required)
Slide courtesy of FEMA
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Supporting Technologies
800MHz radios HAM radios Mission Mode MN-TRAC HAN (Health Alert Network)-
Slide courtesy of FEMA
NIMS Components
Command and Management Preparedness Resource Management Communications and Information
Management Supporting Technologies Ongoing Management and
Maintenance
Ongoing Management and Maintenance NIMS Integration Center
Maintains and manages national-level preparedness standards
Facilitates definition of general training requirements and approved courses
Reviews and approves equipment lists meeting national standards
Defines minimum levels of training, experience, fitness, capability and currency by establishing certification and credentialing standards for key personnel
Develops Corrective Action Plan based on lessons learned from actual incidents
Slide courtesy of FEMA
Group efforts:
Information sharing (ARC, MAC, CST) Communications (web-based future system,
800Mhz, amateur radio) Education (bio, chemical, radiation) Personal Protective Equipment HRSA grant requirements Infectious disease protocols / response Workforce issues Pharmaceutical cache storage and release Drills
Slide courtesy of John Hicks
Federal Assets
National Disaster Medical System (NDMS) Urban Search and Rescue (eg: Nebraska
TF-1) Commissioned Corps Readiness Force Military (NORTHCOM) Federal Medical Stations CDC SNS and VMI
Slide courtesy of John Hicks
NDMS
Disaster Medical Assistance Teams Specialty teams (DMORT, VMAT, Burn, etc) Patient movement:
Public / private partnershipVoluntary commitment of civilian hospital
beds for defense or disaster use – accept casualties from affected area
Response, evacuation, and definitive care2000 hospitals, 65 FCCs
Slide courtesy of John Hicks
NDMS Patient Movement
During crisis, system placed on alert Bed counts submitted to FCC / GPMRC Patient needs matched to beds available Patients arrive by military airlift Distributed to area hospitals Never fully activated until Hurricane
Katrina More mass evacuation than transfers
Slide courtesy of John Hicks
Summary: NIMS Components
Command and Management
Preparedness Resource Management Communications and
Information Management
Supporting Technologies
Ongoing Management and Maintenance
Are You Ready for the Test?
MERET Acknowledges its Partners:
1. Healthcare System Preparedness Program Partnersa. Minnesota Department of Health–Office of Emergency
Preparednessb. MDH Metropolitan Hospital Compactc. Regional Hospital Resource Center Focus Group:
• Michelle Allen, Northwest• Clyde Annala, Northeast• Jill Burmeister, South Central• Chuck Hartsfield, Central• Marla Kendig, Southeast• Emily Parsons, MDH-OEP• Justin Taves, West Central• Eric Weller, South Central
2. FEMA Independent Study Program